Diagnostic and therapeutic treatment modalities for acute lower gastrointestinal bleeding: a systematic review

. 2017 Sep 29;5(10):E959–E973. doi: 10.1055/s-0043-117958

Study (Country) [ref]	Design	Study years	Study population	Interventions	Participants, n	Age, mean ± SD, years	*Shock ^ , n (%)**	Medications on admission, n (%)
Study (Country) [ref]	Design	Study years	Study population	Interventions	Participants, n	Age, mean ± SD, years	*Shock ^ , n (%)**	Anticoagulants	Antiplatelets	NSAIDs
Green 2005 (USA) ⁴	RCT	1993 – 1995	Patients admitted with hematochezia with clinical or laboratory evidence of significant blood loss	Colonoscopy < 8 hours after admission	50	68 ± 3	30 (60.0)	NR	NR	29 (60.0)
Green 2005 (USA) ⁴	RCT	1993 – 1995		Standard care: red cell scan if ongoing bleeding, colonoscopy	50	71 ± 4	34 (68.0)	NR	NR	26 (52.0)
Laine 2010 (USA) ²⁹	RCT	2002 – 2008	Patients admitted with hematochezia with a high-risk feature*	Colonoscopy < 12 hours after admission	36	52 ± 3	27 (75.0)	NR	NR	NR
Laine 2010 (USA) ²⁹	RCT	2002 – 2008		Colonoscopy 36 – 60 hours after admission	36	52 ± 2	31 (86.1)	NR	NR	NR
Albeldawi 2014 (USA) ²⁴	Retrospective cohort	2011 – 2012	All acute LGIB	Colonoscopy < 24 hours after admission	24	66.8 ± 13.8	NR	2 (8.3)	13 (54.2)	2 (8.3)
Albeldawi 2014 (USA) ²⁴	Retrospective cohort	2011 – 2012	All acute LGIB	Colonoscopy > 24 hours after admission	33	69.3 ± 11.1	NR	7 (21.2)	19 (57.6)	3 (9.1)
Ishii 2011 (Japan) ¹⁷	Retrospective cohort	2004 – 2010 2009 – 2010	Patients with colonic diverticular hemorrhage	EBL	16	NR	NR	NR	NR	NR
Ishii 2011 (Japan) ¹⁷	Retrospective cohort	2004 – 2010 2009 – 2010	Patients with colonic diverticular hemorrhage	Endoclipping	48	NR	NR	NR	NR	NR
Jacovides 2015 (USA) ²⁵	Historical control	2005 – 2012	All patients hospitalized with LGIB	Historical protocol: red cell scan, CTA or colonoscopy	78	68 ± 15	NR	NR	NR	NR
Jacovides 2015 (USA) ²⁵	Historical control	2005 – 2012	All patients hospitalized with LGIB	New protocol: CTA, colonoscopy	83	70 ± 15	NR	NR	NR	NR
Jensen 2000 (USA) ³⁰	Historical control	1986 – 1992 and 1994 – 1998	Patients with hematochezia and diverticulosis	Medical and surgical intervention	17	66 ± 3	NR	NR	NR	3
Jensen 2000 (USA) ³⁰	Historical control	1986 – 1992 and 1994 – 1998	Patients with hematochezia and diverticulosis	Medical and endoscopic therapy	10	67 ± 4	NR	NR	NR	3
Nagata 2016 (Japan) ²⁷	Retrospective cohort	2009 – 2014	All patients admitted with acute overt LGIB	Colonoscopy < 24 hours after admission	163	67.9 ± 17.4	17 (10.4)	9 (5.5)	63 (38.7)	23 (14.1)
Nagata 2016 (Japan) ²⁷	Retrospective cohort	2009 – 2014	All patients admitted with acute overt LGIB	Colonoscopy > 24 hours after admission	163	66.4 ± 16.9	19 (11.7)	6 (11.7)	54 (33.1)	20 (12.3)
Nagata 2015 (Japan) ²⁶	Retrospective Cohort	2008 – 2013	Patients admitted with LGIB who underwent colonoscopy	Urgent CTA then colonoscopy	126	68.3 ± 16.5	5 (4.0)	7 (5.6)	55 (43.7)	33
Nagata 2015 (Japan) ²⁶	Retrospective Cohort	2008 – 2013	Patients admitted with LGIB who underwent colonoscopy	Colonoscopy < 24 hours after admission	97	67.7 ± 16.5	1 (1.0)	4 (4.1)	36 (37.1)	13 (13.4)
Nakano 2015 (Japan) ²²	Retrospective cohort	2004 – 2014	Patients undergoing endoscopic therapy for colonic diverticular hemorrhage	EBL	50	67 ± 13	NR	NR	15	4
Nakano 2015 (Japan) ²²	Retrospective cohort	2004 – 2014		Endoclipping	39	64 ± 13	NR	NR	13	3
Sun 2011 (USA) ²⁰	Retrospective cohort	2007 – 2008 and 2008 – 2010	All patients hospitalized with acute GI bleeding	CTA	53	NR	NR	NR	NR	NR
Sun 2011 (USA) ²⁰	Retrospective cohort	2007 – 2008 and 2008 – 2010	All patients hospitalized with acute GI bleeding	Red cell scan	46	NR	NR	NR	NR	NR
Yabutani 2014 (Japan) ²¹	Single retrospective cohort	2010 – 2012	Patients diagnosed with diverticular bleeding	CTA and colonoscopy	57	NR	NR	NR	NR	NR
Yamaguchi 2006 (Japan) ²³	Single retrospective cohort	1999 – 2004	Consecutive patients with hematochezia	Ultrasound and colonoscopy	111	58 (range 18 – 96)	NR	NR	NR	NR
Ketwaroo 2012 (USA) ¹⁸	Retrospective cohort	2010 – 2011	Suspected acute LGIB	CTA	46	68.2 ± 17	NR	NR	NR	NR
Ketwaroo 2012 (USA) ¹⁸	Retrospective cohort	2010 – 2011	Suspected acute LGIB	Red cell scan	46	70 ± 15	NR	NR	NR	NR
Strate 2003 (USA) ²⁸	Retrospective cohort – subgroup	1996 – 1999	All patients admitted with ICD-9 codes representing LGIB, or a wide range of diagnoses associated with LGIB	Colonoscopy < 24 hours after admission	69	NR	NR	NR	NR	NR
Strate 2003 (USA) ²⁸	Retrospective cohort – subgroup	1996 – 1999		Colonoscopy > 24 hours after admission	75	NR	NR	NR	NR	NR
Rodriguez- Moranta 2007 (Spain) 19]	Prospective cohort	2005 – 2006	Consecutive patients admitted with LGIB	Colonoscopy < 24 hours after admission	92	NR	NR	NR	NR	NR
Rodriguez- Moranta 2007 (Spain) 19]	Prospective cohort	2005 – 2006	Consecutive patients admitted with LGIB	Colonoscopy > 24 hours after admission	88	NR	NR	NR	NR	NR

CTA, computed tomographic angiography; EBL, endoscopic band ligation; GI, gastrointestinal; ICD, International Classification of Diseases; LGIB, lower gastrointestinal bleeding; NR, not reported; NSAID, nonsteroidal anti-inflammatory drug; RCT, randomized controlled trial

High risk features defined as heart rate > 100, systolic blood pressure < 100 mmHg, orthostatic changes in systolic blood pressure > 20 mmHg or in heart rate > 20 beats/min, blood transfusion, or drop in hemoglobin ≥ 1.5 g/dL within a 6-hour period.